This project resulted in two articles that are in press, two manuscripts in revisions, and one submitted manuscript. There is also another manuscript that is in development and will be submitted by the end of 2009. In addition, ideas and findings from this study resulted in the development and submission of 3 other manuscripts that did not report data from this study, but instead provided insights into this topic area. Manuscript 1: "Low Plasma Cortisol In PTSD Is Associated With Comorbid Depression But Not With Enhanced Glucocortioid Feedback Inhibition." (In Press Psychoneuroendorcrinology, 2009) This study found that compared to healthy controls, subjects with PTSD+MDD, but not those with PTSD-MDD, exhibited reduced plasma cortisol levels between 1:30 a.m. and 3:30 a.m. and at 4:30 a.m. and 6:30 a.m. Despite similar plasma ACTH levels between groups, ACTH/cortisol and DHEA-S/cortisol ratios were higher in PTSD+MDD patients compared to controls. Plasma DHEA-S levels and cortisol and ACTH response to a low dose dexamethasone suppression test were similar in all 3 groups. This study suggests that a central abnormality is occurring and is consistent with decreased hypothalamic corticotrophin releasing hormone levels and could explain these unique findings. Manuscript 2: "Dispositional traits, coping strategies and re-appraisal are associated with resilience from trauma." Comprehensive Psychiatry, in-revisions Most individuals who experience a trauma are resilient and do not develop post-traumatic stress disorder (PTSD). Results from this study show that the most predictive variables of PTSD resilience in a logistic regression model included a greater purpose in life, less use of self blame as a coping strategy and less identification of the anxious intimate attachment style. In summary, this study identified unique psychosocial variables that are associated with resilience to PTSD may inform the design of novel treatments that foster resilience to trauma, resulting and facilitate recovery from PTSD. Manuscript 3: "Sustained, overnight, elevations of serum interleukin -6 and insensitivity to hydrocortisone differentiates PTSD with co-morbid depression from PTSD without co-morbid depression." Biological Psychiatry, in-revisions. Elevated levels of pro-inflammatory cytokines, especially interleukin-6 (IL-6), are risk factors that could mediate high rates of cardiovascular disease in individuals with posttraumatic stress disorder (PTSD). We found that patients with PTSD+MDD exhibited higher, sustained, serum IL-6 levels compared with PTSD-MDD patients (p=.007) and healthy controls (p<0.001). IL-6 levels did not significantly differ between PTSD-MDD patients and controls (p=0.1). Peak overnight IL-6 levels positively correlated with PTSD symptom severity (r=0.56, p<0.01) and depressive symptoms (r=0.54, p<0.01). Hydrocortisone administration significantly reduced IL-6 levels in both PTSD groups;however, IL-6 levels in the PTSD+MDD group remained significantly higher than in controls. These findings indicate that novel pharmacological and psychological approaches that decrease IL-6 levels could offer a new direction in the prevention and treatment of PTSD, and in the prevention of associated comorbid illnesses. Manuscript 4: "High Emotional Intelligence is Associated with Resilience to Severe Trauma." submitted. Emotional intelligence (EI) is the ability to perceive emotions, to integrate emotions and cognitions, to understand emotions of oneself and others, and use this information to regulate emotions and to promote personal growth. We found that trauma resilient individuals had higher EI compared to PTSD subjects, specifically a greater ability to understand and manage emotions,(strategic EI), despite a similar capacity to perceive emotions. These findings suggest that psychological therapies that enhance strategic EI may foster resilience and prevent PTSD. Manuscript 5: "CSF CRF, IL-6, BDNF, IGF-1 and Substance P in Civilian Posttraumatic Stress Disorder Before and After Paroxetine Treatment." Journal of Clinical Psychiatry, 2009, in press. Posttraumatic stress disorder (PTSD) is associated with altered concentrations of stress-related neurohormones, neuroptrophins and neuropeptides. This study included sixteen medication-free outpatients with PTSD, 11 never traumatized healthy subjects underwent a lumbar puncture (LP) for collection of CSF. We found that compared to healthy controls, patients with PTSD had similar pre-treatment concentrations of CSF CRF, IL-6 BDNF, IGF-1 and substance P, and there were no significant differences compare to controls. Other Related Manuscripts: Manuscript 6: Immune function alterations in PTSD participants. Perspectives in Psychiatric Care, October 45 (4) 2009, 197-211. This review examines studies of immune function in individuals with PTSD to determine if excessive inflammation is associated with PTSD. Conclusions: Current studies suggest an excess of inflammatory actions of the immune system in individuals with chronic PTSD. High levels of inflammatory cytokines have also been linked to PTSD vulnerability in traumatized individuals. There is also evidence that excessive inflammation is in part due to insufficient regulation by cortisol. Manuscript 7: Treating PTSD in primary care. Nurse Practitioner 2009. 35: 10-17. Post-traumatic stress disorder (PTSD) is an anxiety disorder that commonly occurs in primary care patients. Patients with PTSD experience declines in physical and psychological health. This review provides both evidence of physical health alterations associated with PTSD and information for primary care providers to assess and treat PTSD in the primary care setting. Manuscript 8: From Cells to Society: How Gender and Sex Contribute to Resilience, submitted Women and men experience challenges throughout their lives and strive to meet them through a process of resilience. However, individuals differ markedly in their ability to attain resilience depending on the nature of the challenge, and the society, community, and family environment in which she or he lives, as well as intrinsic qualities that influence psychological, physiological, and cellular coping abilities. These heterogeneous trajectories explain many health disparities, and in particular gender disparities.